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Updated: Sep 22, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A detailed echocardiographic evaluation of ventricular functions in stable full term small for gestational age babies
Arjun Verma1, Pradeep Suryawanshi2, Chinmay Chetan3
1Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India.
Insights
Small for gestational age (SGA) newborns with fetal growth restriction exhibit impaired cardiac function. This study found significant systolic and diastolic dysfunction in these infants during the early newborn period.
Area of Science:
- Neonatal Cardiology
- Fetal Growth Restriction
- Cardiac Physiology
Background:
- Infants born small for gestational age (SGA) due to fetal growth restriction (FGR) face challenges adapting to postnatal life.
- Epigenetic factors may contribute to altered cardiac function in these infants.
- Understanding cardiac function differences is crucial for postnatal adaptation.
Purpose of the Study:
- To assess and compare cardiac functions in SGA newborns with FGR versus term, appropriate for gestational age (AGA) newborns.
- To evaluate differences in cardiac function during the critical postnatal transitional circulation period.
- To identify specific echocardiographic parameters indicative of cardiac dysfunction in SGA infants.
Main Methods:
- Observational study including 24 SGA and 30 AGA newborns in Western India.
- Bedside echocardiography performed at 24-48 hours and repeated after 48 hours.
- Assessment included systolic (EF, FS, FAC, TAPSE), diastolic (E/A ratio), and global (LV MPI) function.
Main Results:
- Significantly lower left ventricular systolic function (FS, EF) and right ventricular systolic function (TAPSE, FAC) in SGA infants.
- Altered diastolic function in SGA infants, with a lower tricuspid E/A ratio and higher mitral E/A ratio post-48 hours.
- Elevated left ventricular MPI in SGA infants, indicating global dysfunction, particularly pronounced in those with absent end-diastolic flow.
Conclusions:
- Fetal growth-restricted SGA infants demonstrate significant systolic and diastolic cardiac dysfunction in the early newborn period.
- These cardiac functional deficits impact the infants' ability to adapt to postnatal circulation.
- Echocardiography is vital for detecting and evaluating cardiac dysfunction in growth-restricted neonates.
Purpose:
SGA infants with fetal growth restriction have reduced ability to adapt themselves to the postnatal life because of certain epigenetic changes in cardiac function. The aim of the present study is to assess and compare the cardiac functions of fetal growth restricted SGA newborns to the term stable AGA newborns, and evaluate any differences in the cardiac functions during the postnatal transitional circulation.
Method:
This observational study was conducted at a multispecialty tertiary care hospital in Western India from June to November 2021. The newborns were evaluated using bedside echocardiography at 24-48 h and repeat screening after 48 h. The echocardiographic assessment of the systolic function was done using EF, FS, FAC and TAPSE; diastolic function using E/A wave ratio and global functioning using LV MPI.
Result:
Twnety-four babies were included in cases and 30 in the control arm of the study. Maternal and newborn characteristics were comparable between the two groups. FS, EF for left ventricle and TAPSE, FAC for right ventricular systolic function were significantly lower in SGA group (p = 0.02, 0.02, 0.00 and 0.01; respectively). The current study revealed a lower tricuspid E/A ratio and higher mitral E/A ratio with a significant difference beyond 48 h in the first week of life (p value 0.00). Left ventricular MPI was significantly higher in SGA infants compared to AGA infants during two subsequent readings in immediate newborn period with p values 0.01 and 0.02 respectively. The subgroup analysis revealed that fetal growth-restricted neonates with absent end-diastolic flow had a greater impact on ventricular functions.
Conclusion:
Present study showed a significant systolic and diastolic dysfunction during initial newborn period in growth restricted SGA infants.
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